Most severe austerity measures in Europe are associated with worse child health outcomes

Austerity measures implemented by European countries after the 2008 financial crisis may have adversely affected child health and wellbeing. The authors of the study published today in BMC Public Health discuss these findings and recommend governments consider policies that prevent the negative consequences of austerity measures in the time of COVID-19.

The Great Recession of 2008 was characterized by an economic and financial crisis with a decline in gross domestic product (GDP), high levels of unemployment, and a great impact on European countries and worldwide. Austerity measures taken by governments as a response to this crisis were characterized by reducing social spending and increasing taxation, although they were neither homogeneous nor similarly implemented at European level; some countries protected public sector programs and systems while others instituted large budget cuts in education, healthcare, and other public services. There was general agreement that some countries such as Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. These measures taken by governments would have an impact on the most vulnerable groups, mainly children and youth from disadvantaged families.

The countries that applied high austerity levels showed an increase in material deprivation, child poverty rates, and low birth weight, compared to the pre-austerity period. Higher levels of social protection spending in the period 2008–2013 were associated with lower levels of child poverty. High austerity was reported also to be related to poorer access to and quality of services provided, mainly to disabled children. Reduction of public health expenditure was associated with a reduction of specific vaccination coverage in Italy.

Austerity and COVID-19

It is likely that the indirect effects of the pandemic will have profound impacts for child health in the long run

At the time when we carried out the review, we had not predicted the current COVID-19 pandemic. Early data suggests, unsurprisingly, that the pandemic is impacting the poor and vulnerable most, with stark socio-economic and ethnic inequalities in outcomes. Although there are still many uncertainties regarding the pandemic, it seems that children are less prone to severe consequences of infection compared to adults. However, it is likely that the indirect effects of the pandemic will have profound impacts for child health, particularly poor children, in the long run.

In the acute phase of the COVID-19 crisis, key components of preventive child health services have been negatively affected, e.g. immunization. The unintended consequences of lockdown measures and social distancing are disproportionately affecting poor children, increasing hunger, mental health problems and the risk of abuse, neglect and non-accidental injury. Especially, closure of schools and (day)care facilities may have contributed to lower ‘visibility’ of neglect and domestic violence. In the long run, sustained austerity measures to be expected after the acute phase will damage the capacity of social welfare and health systems to respond.

We recommend governments at European and country level to apply policies that prevent the negative consequences of austerity measures

On the basis of our review, we hypothesize that those areas and countries that applied less austerity measures are in a better condition to respond to the healthcare and social needs of both children and the general population. Moreover, we recommend governments at European and country level to apply policies that prevent such negative consequences of austerity measures. In the near future important research challenges will be to see if the countries with fewer cuts in expenditure on public healthcare and social services are better able to protect health and well-being of children and families, especially in disadvantaged populations, from the consequences of the pandemic.

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Anders Hjern is a Professor of social epidemiology of children and youth at Karolinska Institutet and a Senior Researcher at the Centre for Health Equity Studies (CHESS) in Stockholm, Sweden. His research deals with inequities in child health and vulnerable child populations such as children in care and refugee children and youth.

Dr. Geir Gunnlaugsson his professor of global health at the University of Iceland (UI). He as a MD with post-graduate training in paediatrics (PhD) and public health (MPH) at the Karolinska Institute, Stockholm, Sweden. He has been the director for the Centre of Preventive Child Health Services in Reykjavík and the Chief Medical Officer for Iceland. Research and publications on, e.g., breastfeeding, infant and child mortality, child health and development and abuse, measles, cholera, and health systems in Iceland, Guinea-Bissau and Malawi.

David Taylor-Robinson is a Professor of Public Health and Policy at the University of Liverpool, and affiliate Professor of Child Public Health at the University of Copenhagen. He works clinically as a Consultant in Public Health at Alder Hey Children’s Hospital in Liverpool. His research aims to improve child public health and reduce inequalities. His current work focuses on understanding the causes and consequences of health inequalities in children and assessing the impact of interventions and policies to interrupt the generation of inequalities in health across the life course.

Hein Raat, MD, PhD, MBA is professor at the Dept. of Public Health of Erasmus Medical Center in Rotterdam. He obtained his Medical Degree and PhD at Free University Medical Center in Amsterdam. He is expert in programs to integrate health and social care in regions, and (E-Health) application to enhance well-being and health among high risk groups such as youth and families, frail older citizens and citizens with chronic conditions. He is project leader of the Horizon 2020 VALUECARE project (https://projectvaluecare.eu/ ). He is actively engaged in exchanges between research, policy, and practice. He authored circa 250 scientific publications.

Luis Rajmil (MD, MPH, PhD), Pediatrician and specialist in Epidemiology and Public Health. Retired, he was senior researcher at the Catalan Agency for Health Quality and Assessment (AQuAS, Barcelona, Spain). His research work has been devoted to the health-related quality of life in children and adolescents, and social determinants of health and child health inequalities. He has participated in Spanish, European, and worldwide projects on these subjects. He is member of the International Society for Social Paediatrics and Child Health (ISSOP), and of the International Network for Research in Inequalities in Child Health (INRICH).

Nick Spencer is Professor Emeritus of Child Health in Warwick Medical, University of Warwick, UK.He has a long-standing interest in the social determinants of child health and has published widely around this theme including a book on ‘Poverty and Child Health’ and a book on the biopsychosocial determinants of birthweight. He was President of the International Society for Social Paediatrics and Child Health (ISSOP) from 2003 to 2018. He is co-founder and convenor of the International Network for Research in Inequalities in Child Health (INRICH).